In protecting safety, health, and the environment, government has increasingly relied on cost-benefit analysis. In undertaking cost-benefit analysis, the government has monetized risks of death through the idea of “value of a statistical life” (VSL), currently assessed at about $6.1 million. Many analysts, however, have suggested that the government should rely instead on the “value of a statistical life year” (VSLY), in a way that would likely result in significantly lower benefits calculations for elderly people, and significantly higher benefits calculations for children. I urge that the government should indeed focus on life-years rather than lives. A program that saves young people produces more welfare than one that saves old people. The hard question involves not whether to undertake this shift, but how to monetize life-years, and here willingness to pay (WTP) [what one would pay to obtain a good] is generally the place to begin...In fact, a focus on statistical lives is more plausibly a form of illicit discrimination than a focus on life years, because the idea of statistical lives treats the years of older people as worth far more than the years of younger people.

The paper dealt broadly with how to measure the cost/benefit aspect of government regulations generally, and illustrates how bureaucrats and their enablers are the real kings now. But that aside, its applicability to regulations in a regime of national health care law are obvious and frightening: If regulatory policy is to be based on granting the lives of elderly people a lesser value, it begs for health care rationing that would be supported by terms such as “value of statistical life year,” “willingness to pay”—and other such euphemisms that will no doubt be coined—as bureaucrateze cover for blatant medical discrimination.